Prevention of Ischemic Heart Disease

Introduction

Ischemic heart disease is one of the leading causes of morbidity and mortality worldwide. Prevention plays a crucial role in reducing the incidence of ischemic events and improving both the quality and life expectancy of the population.

Prevention is divided into:

• Primary prevention: Early identification and management of risk factors to prevent the onset of disease.
• Secondary prevention: Strategies to prevent the progression of ischemic heart disease and reduce the risk of acute events in already affected patients.

Cardiovascular Risk Factors

Risk factors for ischemic heart disease are classified as modifiable and non-modifiable.

Non-modifiable risk factors

• Advanced age: The risk increases progressively with age.
• Male sex: Men are more predisposed, although risk increases in women after menopause.
• Family history: The presence of first-degree relatives with early-onset ischemic heart disease (<55 years in men, <65 years in women) increases risk.
• Genetic predisposition: Genetic variants can influence lipid metabolism and vascular inflammation.

Modifiable risk factors

• Dyslipidemia: High LDL cholesterol and low HDL levels promote atherosclerosis.
• Arterial hypertension: Chronic hypertension accelerates vascular damage.
• Diabetes mellitus: Hyperglycemia contributes to endothelial dysfunction and atherosclerosis progression.
• Cigarette smoking: Increases the risk of thrombosis and accelerates the atherosclerotic process.
• Overweight and obesity: Associated with metabolic syndrome and increased oxidative stress.
• Physical inactivity: Lack of physical activity is correlated with a higher risk of ischemic events.
• Unhealthy diet: High intake of saturated fats, refined sugars, and salt promotes atherosclerosis.
• Chronic stress: Negatively influences the autonomic nervous system and cardiovascular metabolism.
• Excessive alcohol consumption: May increase blood pressure and the risk of atrial fibrillation.

Primary Prevention Strategies

Primary prevention focuses on adopting healthy lifestyles and controlling risk factors.

Healthy lifestyles

• Smoking cessation: Cardiovascular risk is significantly reduced after 1–2 years of quitting.
• Regular physical activity: At least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous activity per week.
• Balanced diet: Mediterranean diet rich in fruits, vegetables, fish, and unsaturated oils.
• Weight control: BMI <25 kg/m² and waist circumference <94 cm in men and <80 cm in women.
• Stress management: Relaxation techniques such as yoga, mindfulness, and meditation.
• Moderation in alcohol intake: No more than 2 alcohol units/day for men and 1 unit/day for women.

Screening and monitoring

• Regular blood pressure measurement: Maintain values <130/80 mmHg in at-risk patients.
• Blood glucose and HbA1c control: Fundamental in diabetic subjects or those with insulin resistance.
• Lipid profile: LDL target <115 mg/dL in low-risk patients, down to <55 mg/dL in those at very high risk.
• Global cardiovascular risk assessment: Use of predictive scores such as SCORE2 or ASCVD Risk Calculator.

Secondary Prevention Strategies

In patients with a history of ischemic heart disease, secondary prevention is essential to reduce the risk of recurrence.

Pharmacological therapy

• Antiplatelet agents: Aspirin (75–100 mg/day) ± P2Y12 inhibitors (clopidogrel, ticagrelor).
• Statins: To lower LDL cholesterol levels and stabilize atherosclerotic plaques.
• Beta-blockers: Improve ventricular function and reduce post-infarction mortality.
• ACE inhibitors/ARBs: Indicated in patients with ventricular dysfunction, hypertension, or diabetes.
• Anticoagulants: In patients with atrial fibrillation or high thrombotic risk.

Cardiac Rehabilitation

• Structured exercise programs: Improve functional capacity and prognosis.
• Psychological support: Reduces stress and improves therapeutic adherence.
• Health education: Counseling on lifestyle and treatment adherence.

Conclusion

The prevention of ischemic heart disease requires an integrated approach combining lifestyle modifications, risk factor control, and, in patients with established disease, targeted pharmacological therapies. Regular monitoring and adherence to guidelines are essential to reduce the incidence of ischemic events and improve long-term prognosis.

References
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